PAKISTAN TELECOMMUNICATION EMPLOYEES TRUST

Director Pension, PT&T Building, Mauj-e-Darya Road, Lahore Ph: 042-37243456 Fax: 042-37322080

APPLICATION FORM
FOR DIRECT PAYMENT OF PENSION THROUGH SPECIFIED BANK ACCOUNT
(To be filled in by the Pensioner)

PPO No.
Name of Pensioner Kher Un Nisa

Father / Husband Name Muhammad Pervaiz

Residential Address (Current) H# 188, Khadim Building, Baghicha Hari chand, Kousar Colony, Marir Hassan, Rawalpindi.

Residential Address (Permanent) Dhoke Sain Maskeen, P.O Sagri, mankiala Tehs & Dist Rawalpindi.

Telephone No. 0316-6664488

Cell No. 0336-5105565

Email (if any) mubasher510@gmail.com

Proposed Bank / Branch MCB / Dhoke Chiragh Din Branch

I hereby opt to draw pension through below mentioned Bank account and also submit an
*Indemnity Bond / Lien to the bank. I also provide ACCOUNT VERIFICATION FORM verified
by the Branch Manager as per SOP issued by The State Bank of Pakistan.
*“The pensioner shall produce an indemnity Bond on judicial paper of Rs.20 (Twenty) irrespective of monthly pension drawn to
keep the bank indemnified about liabilities with all sums of money whatsoever including mark-up of his /her pension account.
The pensioner would further undertake that his / her legal heirs, successors, executors shall be liable to refund excess amount if
any, credit to his / her pension account either in full or in installments( as agreed mutually) equal to such excess amount”

(Please also provide copy of CNIC)

Pensioner’s
Dated:_____________ Signature / Thumb Impression

Account Verification Form (to be submitted to Director Pension)

(To be verified by the Bank / Branch Manager as per requirement of The State bank of
Pakistan (vide Circular # 25 dated 4th Nov. 2010))

Account Title (Name)

Kher Un Nisa
Account No.
0551 1274 5100 0833
(Only for Pension not being a Joint Account )
Bank Name / Branch
MCB / Dhoke Chiragh Din Branch

Bank Address Dhoke Chiragh Din, Marri Hassan, Rawalpindi.

Branch Code 1115

Indemnity Bond / Lien submitted by the Pensioner

Bank / Branch Manager

Signature Stamp:
Dated:
----------------------------------------------------------------------------------------------------
Acknowledgement to be issued by Pension Directorate Lahore

Acknowledgement Receipt No.__________________ Signature of Officer _________________

Date _________________
 INDEMINITY BOND
To,

The Manager,

_______________________________ (Name of Bank)

_______________________________ (Branch)

_______________________________ (City)

In compliance with the SBP’s instruction for payment of pension through your Bank branch I /
we agree to indemnify you and keep you indemnified about liabilities with all sums of money
whatsoever including mark-up of my Pension Account. I / we further undertake that my / our
legal heirs, successors, executors shall be liable to refund excess amount, if any, credited to my /
our Pension Account either in full or in installment equal to such excess amount.

Co-Indemnifier / Nominee / Successor Signature: __________________________

Next of Kin: Name of Pensioner: _____________________

CNIC: ________________________ Date of Retirement: _ _______

Address:______________________ PPO No: ___________________

______________________________ Bank Account No:____________________

Signature:______________________ CNIC: ______________

Witness-I Witness-II
NAME: _______________________ NAME: ____________________________
CNIC: ________________________ CNIC: _____________________________
Contact No: ___________________ Contact No: _________________________

Signature ______________________ Signature __________________________

Date: _________________________ Date: ______________________________